No-Fault Case Law

The court considered a case in which a medical provider was attempting to recover no-fault benefits from an insurance company after an alleged accident. The insurance company had moved for summary judgment to dismiss the complaint, arguing that the insured vehicle was not involved in the accident. The court considered the transcript of the examination under oath of the insured, where she testified that no accident had occurred and that the plaintiff's assignor, a pedestrian, had not been struck by her vehicle. The court found that this was sufficient evidence to demonstrate that the alleged injury did not arise out of an insured incident, and as the plaintiff had failed to raise a triable issue of fact in opposition to the motion, the order granting the insurance company's motion for summary judgment was affirmed.

The court considered the denial of a motion for summary judgment by the plaintiff and a cross-motion for summary judgment by the defendant in a case involving a provider trying to recover assigned first-party no-fault benefits. The court found that the plaintiff had established that it had mailed the bill to the defendant, that the bill was unpaid, and that the defendant had timely denied the claim. The main issue decided was whether the defendant had a basis for denying the claim, specifically related to the assignor fraudulently procuring the insurance policy by misrepresenting her address to obtain a lower premium. The holding of the court was that the defendant failed to establish as a matter of law that it would not have issued the same policy if the correct information had been disclosed in the application, and that the doctrine of collateral estoppel was not applicable as the plaintiff was not named in the related action.

The court considered a dispute involving Nationwide and State Farm insurance companies over their obligation to defend and indemnify Lisette Oster in a wrongful death action. The case revolved around an incident where Lisette's negligent actions allegedly led to Mr. Daniele's death. Nationwide denied coverage, claiming the incident fell under an automobile policy exclusion, while State Farm asserted it had no obligation to defend. The main issues included the interpretation of insurance policies, the duty to defend, and the alleged bad faith of Nationwide. The court held that Nationwide must provide coverage and defend Lisette, as its duty was broader than the duty to indemnify. State Farm was not obligated to defend Lisette. The court also allowed Lisette to recover attorney's fees, but Mrs. Daniele was not entitled to do so. Finally, the court dismissed the complaint and granted Lisette's counterclaims.

The court considered the facts that the defendant-insurer had mailed notices for examinations under oath to the plaintiff's assignor, who failed to appear at the scheduled EUOs. The main issue decided was whether the defendant was entitled to summary judgment dismissing the action for first-party no-fault benefits based on the assignor's nonappearance at the EUOs. The holding of the case was that the defendant had made a prima facie showing of entitlement to summary judgment by establishing the timely and proper mailing of the EUO notices and the assignor's repeated failure to appear. The court found that the plaintiff did not specifically deny the assignor's nonappearance or raise a triable issue, and affirmed the lower court's order granting summary judgment in favor of the defendant.

The main issues in this case involved a dispute over first-party no-fault benefits for services provided after a motor vehicle accident. The defendant, Allstate Insurance Company, argued that the plaintiff's action should be dismissed based on collateral estoppel and because the defendant did not have a policy that covered the plaintiff's assignor at the time of the accident. However, the court found that the defendant's evidence was insufficient to demonstrate that the plaintiff was attempting to relitigate an issue that had been raised in prior actions, and the defendant had not proven that the insurance policy had been validly cancelled. As a result, the court reversed the order granting the defendant's motion for summary judgment and denied the motion to dismiss the complaint.

The court considered the denial of claim form, peer review report, and lack of medical necessity for the services at issue. The main issue decided was whether the denial of the claim on the ground of lack of medical necessity had been timely mailed, and if there was a factual basis and medical rationale for the neurologist's determination. The holding of the case was that the order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint was affirmed. The court found no merit to plaintiff's argument that defendant's cross motion should have been denied, and that plaintiff's inaction may not now be used as a means to defeat the defendant's cross motion.

The court considered the fact that the defendant timely and properly denied the plaintiff's no-fault claims for acupuncture needle reinsertion services based on the assignor's sworn statement denying that such services were performed. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint. The court held that the defendant was entitled to summary judgment dismissing the claims, as the plaintiff's proof, consisting of an attorney's affirmation, was insufficient to raise a triable issue as to whether the needle reinsertions were actually performed. Additionally, it was undisputed that the plaintiff did not fully respond to the defendant's verification request, therefore the thirty-day period to pay or deny the claims did not begin to run, making the remaining claims not overdue and the plaintiff's action on those claims premature.

The relevant facts considered by the court were that the plaintiff, Global Liberty Insurance Company of New York, provided a policy of insurance to its insured that included a no-fault endorsement providing coverage to an insured in the event of a motor vehicle accident. The defendant, Rosalee Otero, failed to attend properly scheduled independent medical examinations (IMEs) as required under the policy. The main issue decided by the court was whether the defendant's failure to attend the scheduled IMEs constituted a breach of a condition precedent to coverage under the no-fault policy. The court held that the defendant's non-appearance at the IMEs constituted a failure of a condition precedent to receipt of insurance benefits for the motor vehicle accident, and as a result, the plaintiff was entitled to summary judgment. The holding of the case was that the defendant was not entitled to no-fault coverage for the subject motor vehicle accident, and all related Civil Court matters and no-fault arbitrations were permanently stayed.

The relevant facts included the plaintiff, a provider seeking to recover no-fault benefits, opposing the defendant's motion to dismiss the complaint on the ground of lack of personal jurisdiction. The defendant, a Pennsylvania company not licensed to do business in New York, argued that the Civil Court lacked personal jurisdiction over it. The plaintiff's opposition to the motion included assertions that the defendant had transacted business in New York by issuing policies to New York drivers and establishing an ongoing relationship with defense counsel in New York. The main issue decided was whether personal jurisdiction had been obtained over the defendant, and whether the plaintiff's opposition to the motion was sufficient to demonstrate that personal jurisdiction existed. The court held that the plaintiff's opposition was insufficient to establish personal jurisdiction over the defendant under the Civil Court's long-arm statute, as plaintiff's counsel failed to establish personal knowledge of the facts. The holding of the case was that the defendant's motion to dismiss the complaint was granted, as it had made a prima facie showing that personal jurisdiction had not been obtained over it, and the plaintiff's opposition was insufficient to demonstrate personal jurisdiction under the Civil Court's long-arm statute. Therefore, the order denying the defendant's motion to dismiss the complaint was reversed.

The court considered the fact that the defendant had timely denied the claim based on the alleged intoxication of the plaintiff's assignor, who was operating the vehicle at the time of the accident. The main issue was whether there was a triable issue of fact as to the timeliness and propriety of the denial of the claim. The holding of the court was that the judgment was reversed, the portion of the order granting the plaintiff's motion for summary judgment was vacated, and the plaintiff's motion was ultimately denied. The court found that the defendant had raised a triable issue of fact as to whether the claim had been timely and properly denied based on the alleged intoxication of the plaintiff's assignor.